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Support the Independence at Home Act

If you are interested in advocating for improved care for patients with multiple chronic illnesses, or just fed up with how care is delivered for the most frail, vulnerable, and costly Medicare beneficiaries, it's time to act. Congress has in it's lap the Independence at Home Act of 2009. This act amends title XVIII of the Social Security Act to authorize voluntary home care coordination pilot programs for high-cost Medicare beneficiaries with multiple chronic conditions.

These pilot programs would focus on beneficiaries with two or more specified high cost chronic illnesses that have utilized certain Medicare benefits in the past 12 months, and that have an inability to perform two or more ADLs. The pilot programs will put together a team that consists of health care professionals directed by a qualified IAH physician or nurse practitioner who coordinates health care across all treatment settings. Best of all these programs will pay for themselves out of the gate because they must meet three performance standards including

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Here's a draft email (templated by Helen Kao) I sent to Senator Feinstein about this issue. Readers -- feel free to adapt this to email your congressperson about this critical issue!

June 12, 2009

Dear Senator Feinstein;

As one of your constituents, I strongly encourage you to support the Independence at Home Act (HR 2560, S 1131) which was re-introduced May 21, 2009. This legislation has bipartisan support in both chambers, pays for itself out of the gate, saves money, and improves care for the most frail, vulnerable, and costly Medicare beneficiaries.

The model is based on technology-enabled home visits by an interdisciplinary team led by physicians and nurse practitioners, and includes electronic health records as part of the mandated process. The financing employs a combination of existing fee-for-service payments plus shared savings after demonstrating value returned. There is mounting evidence that this care model is highly effective. The Act leaves the main elements of Medicare in place, requires little capitalization for the new programs, provides freedom of choice for beneficiaries, and thus will be readily implemented. There are practices across the country, including in our state that are capable of this model of care and are ready to move forward. For a current example, see the recent CNN story at: http://www.cnn.com/2009/HEALTH/05/25/hm.doctor.house.call/

By directly engaging medical care teams, the Independence at Home (IAH) Act corrects a key weakness that has historically limited the effectiveness of Part A home health care services, and it addresses Transitional Care. For these frail, poorly mobile patients who have difficulty accessing office-based care, IAH is a better plan than the Patient-Centered Medical Home (PCMH) and will be complementary to PCMH efforts. By paying for itself out of the gate, Independence at Home is unique among current legislative proposals. IAH will stimulate growth of a badly needed geriatric workforce, and most importantly IAH will provide the medical care that people want and need, when they want it, and where they want it.

The Independence at Home Act calls for a 3-year pilot phase in multiple states, followed by national roll-out if the initial efforts are successful based on independent evaluation.

26 organizations have signed on to endorse IAH, including AARP, Family Caregiver Alliance, and the Alzheimer’s Association.

Bipartisan support in both houses is growing, with the recent addition of Senators Kennedy and Mikulski, joining Wyden who introduced the Senate version and Burr, plus Cardin and Whitehouse.

Your timely support (this week) for this bill (HR 2560, S 1131) will be a great help toward advancing this forward-thinking proposal for Medicare reform.

Thanks for the information about this. I'm wondering if mental health issues - depression, bipolar, schizophrenia - are being considered chronic conditions under this proposed legislation. Individuals with serious mental health issues many of whom have Medicare have significantly lower life expectancies than the national average and a high prevalence of co-morbid conditions. It might be worth exploring applicability of the legislation to this population and you may be able to broaden its support.

TO be eligible for the pilot studies one needs to have functional impairment and have 2 or more of the following chronic conditions: Congestive heart failure, Diabetes, COPD, Ischemic heart disease, Peripheral arterial disease, Stroke, Dementia, Pressure ulcers, Hypertension, Neurodegenerative diseases, and "Any other chronic condition that the Secretary identifies as likely to result in high costs to the program". I'm not sure if significant mental health issues would fall in the last condition.

Mental health conditions (mood and anxiety disorders, psychotic disorders, dementia) are common among the homebound, particularly the homebound elderly. These psychiatric disorders often interact with comorbid medical conditions and can greatly influence understanding/adherence to medical recommendations. As a psychiatrist who treats homebound elderly patients with mental illness (and invariably a host of chronic physical disorders), liaison with primary care and other medical providers is a major part of what I do. It would be poor medical treatment indeed to omit the treatment of mental disorders while trying to promote independence at home.

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